Technology and The Future of Mental Health Treatment

Excitement about the huge range of opportunities has led to a burst of app development. There are thousands of mental health apps available in iTunes and Android app stores, and the number is growing every year. However, this new technology frontier includes a lot of uncertainty. There is very little industry regulation and very little information on app effectiveness, which can lead consumers to wonder which apps they should trust.

Before focusing on the state of the science and where it may lead, it’s important to look at the advantages and disadvantages of expanding mental health treatment and research into a mobile world.

• Convenience: Treatment can take place anytime and anywhere (e.g., at home in the middle of the night or on a bus on the way to work) and may be ideal for those who have trouble with in-person appointments.
• Anonymity: Clients can seek treatment options without involving other people.
• An introduction to care: Technology may be a good first step for those who have avoided mental health care in the past.
• Lower cost: Some apps are free or cost less than traditional care.
• Service to more people: Technology can help mental health providers offer treatment to people in remote areas or to many people in times of sudden need (for example, following a natural disaster or terror attack).
• Interest: Some technologies might be more appealing than traditional treatment methods, which may encourage clients to continue therapy.
• 24-hour service: Technology can provide round-the-clock monitoring or intervention support.
• Consistency: Technology can offer the same treatment program to all users.
• Support: Technology can complement traditional therapy by extending an in-person session, reinforcing new skills, and providing support and monitoring.

This new era of mental health technology offers great opportunities but also raises a number of concerns. Tackling potential problems will be an important part of making sure new apps provide benefits without causing harm. That is why the mental health community and software developers are focusing on:

• Effectiveness: The biggest concern with technological interventions is obtaining scientific evidence that they work and that they work as well as traditional methods.
• For whom and for what: Another concern is understanding if apps work for all people and for all mental health conditions.
• Guidance: There are no industry-wide standards to help consumers know if an app or other mobile technology is proven effective.
• Privacy: Apps deal with very sensitive personal information so app makers need to be able to guarantee privacy for app users.
• Regulation: The question of who will or should regulate mental health technology and the data it generates needs to be answered.
• Overselling: There is some concern that if an app or program promises more than it delivers, consumers may turn away from other, more effective therapies.

“Self-management” means that the user puts information into the app so that the app can provide feedback. For example, the user might set up medication reminders, or use the app to develop tools for managing stress, anxiety, or sleep problems. Some software can use additional equipment to track heart rate, breathing patterns, blood pressure, etc. and may help the user track progress and receive feedback.

Apps for Improving Thinking Skills

Apps that help the user with cognitive remediation (improved thinking skills) are promising. These apps are often targeted toward people with serious mental illnesses.

Skill-Training Apps

Skill-training apps may feel more like games than other mental health apps as they help users learn new coping or thinking skills. The user might watch an educational video about anxiety management or the importance of social support. Next, the user might pick some new strategies to try and then use the app to track how often those new skills are practiced.

Illness Management, Supported Care

This type of app technology adds additional support by allowing the user to interact with another human being. The app may help the user connect with peer support or may send information to a trained health care provider who can offer guidance and therapy options. Researchers are working to learn how much human interaction people need for app-based treatments to be effective.

Passive Symptom Tracking

A lot of effort is going into developing apps that can collect data using the sensors built into smartphones. These sensors can record movement patterns, social interactions (such as the number of texts and phone calls), behavior at different times of the day, vocal tone and speed, and more. In the future, apps may be able to analyze these data to determine the user’s real-time state of mind. Such apps may be able to recognize changes in behavior patterns that signal a mood episode such as mania, depression, or psychosis before it occurs. An app may not replace a mental health professional, but it may be able to alert caregivers when a client needs additional attention. The goal is to create apps that support a range of users, including those with serious mental illnesses.

Data Collection

Data collection apps can gather data without any help from the user. Receiving information from a large number of individuals at the same time can increase researchers’ understanding of mental health and help them develop better interventions.

• Ask a trusted health care provider for a recommendation. Some larger providers may offer several apps and collect data on their use.
• Check to see if the app offers recommendations for what to do if symptoms get worse or if there is a psychiatric emergency.
• Decide if you want an app that is completely automated or an app that offers opportunities for contact with a trained person.
• Search for information on the app developer. Can you find helpful information about his or her credentials and experience?
• Beware of misleading logos. The National Institute of Mental Health (NIMH) has not developed and does not endorse any apps. However, some app developers have unlawfully used the NIMH logo to market their products.
• Search the PubMed database offered by National Library of Medicine (http://www.ncbi.nlm.nih.gov/pubmed/ ). This resource contains articles on a wide range of research topics, including mental health app development.
• If there is no information about a particular app, check to see if it is based on a treatment that has been tested. For example, research has shown that Internet-based cognitive behavior therapy (CBT) is as effective as conventional CBT for disorders that respond well to CBT, like depression, anxiety, social phobia, and panic disorder.
• Try it. If you’re interested in an app, test it for a few days and decide if it’s easy to use, holds your attention, and if you want to continue using it. An app is only effective if keeps users engaged for weeks or months.

• Feasibility, efficacy, and effectiveness research
• Technology for disorders such as schizophrenia, HIV, depression, anxiety, autism, suicide, and trauma
• More interventions for cognitive issues, illness management, behavior, and health communication
• Fewer interventions for a personal computer and more interventions for mobile devices
• More engaging ways to deliver therapies or skill development (for example, interactive formats or game-like approaches)
• Real-time (users exchanging information with peers or professionals as needed)
• Active and passive mobile assessment/monitoring

In addition, NIMH created the National Advisory Mental Health Council Workgroup on Opportunities and Challenges of Developing Information Technologies on Behavioral and Social Science Research to track and guide the cutting edge of this rapidly-changing area.

The Future: What Types of Research Does NIMH Expect in the Future?

Recently, there has been increased interest in:

• Using mobile technology for a wider range of disorders, from mild depression or anxiety to schizophrenia, autism, and suicide
• Developing and refining new interventions, instead of adapting existing interventions to work with new technologies
• Developing technologies that work on any device
• Incorporating face-to-face contact or remote counseling (phone or online) to provide a balance between technology and the “human touch”